Train Your Mind, Change Your Brain

Train Your Mind, Change Your Brain – Sharon Begley
Excerpt: Mind over Matter – pages 141-150

Thinking Depression
Just as the UCLA scientists were discovering that a mind-based, cognitive therapy can change the brain—that thinking about your thoughts in a certain way can alter the electrical and chemical activity of a brain circuit—science was embroiled in a bitter debate over whetherpsychotherapy has any effect whatsoever, let alone on the physical structure and activity of the brain. The controversy centered on depression. On December 29, 1987, the U.S. Food and Drug Administration had given the pharmaceutical giant Eli Lilly and Company approval to sell fluoxetine hydrochloride as a treatment for depression. Marketed as Prozac, the drug was featured on the covers of magazines,starred in newspaper stories, inspired bestselling books, and was soon racking up $2 billion in annual sales. Prozac was not just another drug for depression. It was hailed as a compound that specifically targeted the disease's underlying neurochemical cause, supposedly a paucity of the neurotransmitter serotonin in the brain's synapses. The rise of Prozac coincided with the continuing fall fromgrace of psychotherapy. Expensive, time-consuming, and the subject of more jokes than rigorous scientific studies, psychotherapy was starting to have the whiff of something as antediluvian as Freud's couch. Which is not to say that psychotherapists were throwing in the towel. To the contrary. In 1989, scientists reported the results of the most ambitious study ever undertaken to examine theeffectiveness of psychotherapy compared to medication in treating depression. Called the Treatment of Depression Collaborative Research Project, this two-year study was funded and organized by the National Institute of Mental Health. Two hundred and fifty outpatients with major depression were randomly assigned to receive one of four treatments: interpersonal psychotherapy, cognitive-behavior therapy,imipramine (a common antidepressant), or an inert pill. In the last two cases, patients also received what is called clinical management, which essentially means they saw a psychiatrist to receive their medication.

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Train Your Mind, Change Your Brain – Sharon Begley
Excerpt: Mind over Matter – pages 141-150 Cognitive-behavior therapy, which was developed in the 1960s, does notdwell on causes of depression. It focuses instead on teaching patients how to handle their emotions, thoughts, and behaviors. The idea is to reappraise dysfunctional thinking, to see the fallacy of thoughts such as "The fact that I was not offered that job means I am doomed to be unemployed and homeless." Patients learn to think about their thoughts differently and not to ruminate endlessly aboutminor setbacks. Instead of seeing a failed date as evidence that "I am a total loser, and no one will ever love me," patients learn to view it as just one of those things that didn't work out. Instead of seeing a leaky roof as a sign that "nothing will ever go right for me," they think of it as "Stuff happens." They learn to recognize their tendency to magnify disappointments into calamities andmishaps into tragedy, and to test the accuracy of their extreme beliefs. If they are convinced that no one will ever like them, the therapist encourages them to join a social group and strike up a conversation and possibly a friendship. Such reality testing will show patients that they are unrealistically pessimistic. With their newfound cognitive skills, patients can experience sadness and setbackswithout being sucked into the black hole of depression. Interpersonal therapy, on the other hand, recognizes that although depression may not be caused by interpersonal relations or experiences, it affects them. It therefore targets interpersonal disputes and conflicts, role transitions such as becoming an empty nester, and complicated and persistent grief. In all four groups, patients suffered...